How can we improve health care coverage?

As the state with the highest poverty rate and the lowest median income, it should be no surprise that Mississippi has the highest medical debt of all states. According to a recent Urban Institute report, nearly 40 percent of all Mississippians have outstanding debts for medical care.

Medical debt in our state remains the leading cause of personal bankruptcies, according to the Mississippi Health Advocacy Program. State leaders chose not to expand Medicaid to adults in poverty, so we continue to have a large number of people without health insurance. Middle-income Mississippians have tended to choose less expensive, high-deductible health insurance. Some of these plans pay only 60 percent of medical bills, and many patients hit with hospitalizations or other unexpected high-cost medical treatment simply do not have the money to pay the remaining 40 percent due.

These past-due bills, very often from middle-income people, have hit Mississippi hospitals hard. Having already lost much of the Medicaid payments that once helped to make up for non-paying patients, hospitals were hoping something would happen with the proposed American Health Care Act to help hospitals like many in Mississippi that care for a large proportion of lower-income patients. Instead, the doomed American Health Care Act would have resulted in millions more uninsured Americans.

Donald Trump ran a populist campaign for the presidency, but he could not have won without the Republican Party behind him. The two ideological wings of the Trump campaign ran smack into each other in Congress’ unsuccessful effort to repeal and replace the Affordable Care Act.

During his campaign, Trump promised there would be a replacement for Obamacare that was better and would protect all Americans. Not having learned former President Obama’s lesson, Trump also promised that everyone would be able to keep their doctor and their health plan, and that health insurance would be affordable for everybody. Unfortunately, the proposed GOP Obamacare replacement was not designed to keep any of these promises.

The proposed plan did keep the provision protecting the ability of people with preexisting conditions to get insurance. Since this rule only works if people do not wait until they get sick to get coverage, insurance companies wanted more carrots and sticks to get healthy people to sign up. They got the stick. The proposed plan would have allowed charges of up to 30 percent more for anyone who dropped coverage for any reason.

What many insurance companies think would work better is to be able to offer cheaper plans designed only for young people. These plans for Young Invincibles would look more like catastrophic coverage only for high-cost health care like cancer and trauma care. And with coverage for birth control and maternity care that young women want and need so they can increase their odds of having a healthy baby.

Both insurance companies and people in more rural states like Mississippi also want different ways to better manage insurance pools so their small businesses can afford to provide health insurance for employees, and people living in small towns can have more choices of insurers. Reviving the state insurance marketplaces could help do just that.

The AP reports that about one-third of the 3,100 counties in the U.S. have only one health insurance company offering coverage. These are generally small rural counties with low populations. Big cities, because of both their population density and easier access to health care, have more health insurance choices at lower cost. Many Americans living in rural counties, a good many of whom helped put Trump into office, need subsidies to be able to afford health insurance. And the health care system would benefit from expansion of a current Medicare provision that provides additional federal dollars to insurers with unexpectantly high-cost beneficiaries.

And in case you are wondering how the government could afford to put more money into U.S. health care, the Congressional Budget Office now says that the ACA costs are about one-third of what was originally estimated.

Another potential change that would make Obamacare better and decrease costs is to put more emphasis on preventive health care and allow employers and insurers to incentivize policy holders to not smoke, to lose weight, to eat more healthy foods and to get regular exercise. Our national obesity epidemic only fuels the growth in U.S. health care costs. There is now plenty of medical evidence showing that diet and exercise work just as well if not better than prescription drugs to keep people healthy.

One final recommendation for improving Obamacare is to just change the name. There is that promise to get rid of Obamacare, and making needed improvements may not be enough for some people. How about the Great American Health Care Act, which has, you must admit, a certain ring to it.

Lynn Evans is a former Jackson School Board Member and a contributing columnist.